Extrauterine epithelioid trophoblastic tumors presenting as primary lung carcinomas: Morphologic and immunohistochemical features to resolve a diagnostic dilemma Journal Article
| Authors: | Lewin, S. N.; Aghajanian, C.; Moreira, A. L.; Soslow, R. A. |
| Article Title: | Extrauterine epithelioid trophoblastic tumors presenting as primary lung carcinomas: Morphologic and immunohistochemical features to resolve a diagnostic dilemma |
| Abstract: | Our objective was to describe the clinicopathologic features of epithelioid trophoblastic tumors (ETTs) in a series of patients who presented with elevated β-human chorionic gonadotrophin (hCG) levels and extrauterine lesions resembling primary lung carcinomas. Clinical and pathologic materials were reviewed and Shih and Kurman's diagnostic criteria were applied. Three parous women (38, 49, and 34 y of age) with elevated β-hCG levels had nondiagnostic gynecologic evaluations, including negative dilation and curettage specimens. Imaging revealed isolated pulmonary lesions, 2 to 8.5cm in size, resembling primary lung carcinomas. Two patients received multiagent chemotherapy consisting of etoposide, methotrexate, dactinomycin, alternating with cisplatin and etoposide, and all underwent pulmonary resection. Histologically, the cytologic features, epithelioid growth pattern, and hyaline-like material simulated the appearance of nonsmall cell lung carcinoma, but overall, the histologic features along with the immunophenotype supported classification as ETT. Follow-up hysterectomy specimens were histologically normal. All 3 patients are alive and well. The rarity of ETT and its resemblance to squamous and pleomorphic carcinomas of lung have led to diagnostic difficulties. When reproductive-age women present with elevated β-hCG levels, a pulmonary lesion, and no apparent intrauterine disease, primary pulmonary ETT should be considered. Correlating clinical indices with specific morphologic and immunohistochemical features can ensure diagnostic accuracy and appropriate treatment for favorable outcomes. © 2009 by Lippincott Williams & Wilkins. |
| Keywords: | immunohistochemistry; adult; treatment outcome; middle aged; case report; chemotherapy, adjuvant; antineoplastic agent; diagnosis, differential; lung resection; antineoplastic combined chemotherapy protocols; lung neoplasms; pneumonectomy; differential diagnosis; tumor markers, biological; pathology; tumor marker; lung tumor; blood; chemistry; adjuvant chemotherapy; prediction and forecasting; predictive value of tests; pregnancy; immunophenotyping; upregulation; up-regulation; epithelioid cell; thoracoscopy; endometrium; epithelioid trophoblastic tumor; extrauterine lesion; nonsmall cell lung carcinoma; chorionic gonadotropin beta subunit; trophoblastic tumor; chorionic gonadotropin, beta subunit, human; epithelioid cells; trophoblastic neoplasms |
| Journal Title: | American Journal of Surgical Pathology |
| Volume: | 33 |
| Issue: | 12 |
| ISSN: | 0147-5185 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2009-12-01 |
| Start Page: | 1809 |
| End Page: | 1814 |
| Language: | English |
| DOI: | 10.1097/PAS.0b013e3181b9cd67 |
| PUBMED: | 19773636 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 30 November 2010" - "CODEN: AJSPD" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
-
176Moreira -
793Soslow -
607Aghajanian -
16Lewin
Related MSK Work